Three comments in 24 hours is disgusting. Are you guys alive? Are you capable of fighting for your future? On a slow day, 200 interested people visit this site. A really good day (When we are going after the Big Three) close to 700. Three comments? Are you brain dead? This is the primary issue. The lack of respect from your company, dignity, self-respect and dignity are secondary issues. The fact that the Pharmacy Benefits Managers (Big banks) have been working to take over your profession is the most important issue in your life. If they get what they want, it is over. They are big banks and you know all about big banks. Once they control the money flow completely, you personally, are fucked. Everyone of us needs to send comments to the Oregon Pharmacy Association, NACDS and NACP and congratulate them and urge them to keep going. There are 49 other states. Oregon has pulled back on the PBM reins. Your state next? When you get all itchy about your pathetic bathroom issues and wetting your pants, consider that money is being robbed from You. WAG stood up. Your company?

Count them. 6 Pharmacists on duty.

Oregon institutes PBM bill

By Michael Johnsen

ALEXANDRIA, Va. — Oregon Gov. John Kitzhaber, D, has signed what the National Association of Community Pharmacy has characterized as groundbreaking reform legislation that applies reasonable standards to how pharmacy benefit managers audit community pharmacies, provides increased transparency into generic prescription drug reimbursement and ensures that PBM administrators of prescription drug claims are registered within the state.

Members of a Pharmacy Working Group, consisting of Oregon pharmacists, representatives of the Oregon Pharmacy Association, the National Association of Chain Drug Stores, NCPA, the Oregon Pharmacy Coalition, state legislators and representatives of the PBM community have collaborated on these issues over the past year, NCPA noted.

“Oregon is demonstrating its leadership in the healthcare arena,” stated Douglas Hoey, NCPA CEO. “This new law will help Oregon’s clinically trained pharmacists — the medication experts — to devote more time to their patients. The bill contains three notable provisions that will ultimately benefit any Oregon patient who enters a retail pharmacy.”

Specifically, the bill will curb excessive pharmacy audit practices in pursuit of minor technicalities or trivial clerical errors. The bill will also require PBMs to update their reimbursement rates more frequently to better reflect the pharmacy’s actual drug acquisition costs, which can increase dramatically and virtually overnight. Also, the bill requires PBMs to register with the Insurance Division of Oregon, a step toward some level of regulatory oversight of the drug benefit management industry within the state.

52 Comments

A great bill which lays the foundation to creating an EQUAL playing field that would truly reward a Pharmacy provider based upon their customer service levels. This Bill will hopefully motivate more state pharmacy associations to get legislation of similar language crafted in all 50 states and DC…..

Let’s see.. It was Oregon that had the survey of RPH’s that ~ 75% of the chain RPH’s said that they considered their work environment – DANGEROUS…
–
There has been TWO annual meetings of the NABA.. and to the best of my knowledge.. only MS or AL has tried to reign in the PBM industry by promulgating rules that would bring the PBM industry under the BOP. To which – as I understand it – the PBM industry threatened to keep the BOP in court until the state ran out of money or hell froze over.. whichever came first.
–
It would not appear that – collectively – the BOP’s are in no hurry to improve the safety in the pharmacy work environment.

That is good news about Oregon. They are still leading the way in pharmacy reform….they ‘get it’…they understand pharmacy and it looks like the pharmacy board members are no wimps. It is nice to see some positive news in the world of pharmacy.

The other prescription for battling PBMs and chain abuses: open your own store. Build your following at a chain, open a mile or two from the chain after five years, and then take the best techs with you. Don’t worry about the low reimbursement rates. The chains have to deal with the low reimbursement also. Remember all those lost tech hours due to decreased reimbursement? You can reclaim them in your own store. And remember if Walgreens can average ~$250,000 net profit per store (2.1 billion net profit in 2012/8100 stores) AND pay their executive team 25 million in salary, then you can earn your 130K salary plus 100k-200k extra. More independents=more money in your pocket to donate to organizations like PUTT that puts pressure on the PBM industry. Say goodbye to shitty gimmicks and start really taking care of people. You’ll be happier, healthier, and wealthier.

Jim there are no comments because who cares? I liken pharmacists who demonizing PBMS and blame them for all their problems to how you demonize the DEA for going after pharmacy chains. In both cases neither one is addressing the real problem.

You think it is bad now? Wait until Obama Care kicks in. Hospitals are already suffering the rath of Government run healthcare. Wait until you have the Obama Care Heath Insurance Exchange auditing contractors crawling up your asses like the CMS auditing contractors are doing right now to hospitals. CVS picking on you for a few technicalities will seem like childs play.

The ship has sailed a long time ago Jim. Pharmacy is about one thing now. The distribution of a product as quickly and cheaply as possible.

Jim, I respect your experience and your opinion however your insight into the real issues facing the healthcare system don’t extend much beyond the lip of your counting tray.
.
.
.
Pharmacists, independants especially, love to blame the dastardly PBMs for all their pain and misery. If it weren’t for PBMs the prescription drug portion of our healthcare system would have collapsed years ago. The cost of every newly diagnosed patient with Type II diabeties, hypertension, GERD, and osteoarthritis being put directly on Glumetza, Tradjenta, Nexium, and Celebrex alone would have been enough to bankrupt the sysyem. These ae just a few examples out of hundreds of drugs.

2) They set OUR PRICES. They increasingly are setting MAC values (maximum allowable cost) at below AQ on a number of generics and when those generics go up in price substantially (recently Desonide cream) they are months behind in updating their MAC prices and for desonide i’m losing ~$80 per tube.

Futher PBMs are complicit in the exploding costs of medication. One way is b/c they take KICK BACKS from manufacturers for making certain medications formulary (nexium) and others not (dexilant). How do you think these manufacturers pay for these kick back incentives that they pay the PBMs? by increaing the cost of medication every 3-4 months…nexium just went from $190 for 30 ct to $215 for no reason other than the drug companies CAN charge more. When middlemen are more profitable than the people proving the services there is something terribly wrong.

So broncofan7 getting rid of PBMs solves everyones problem? Not hardly! PBMs are complicit in exploding costs in the same way pharmacists are complicit in the explosion of prescription drug abuse.
.
.
The mess we’re in now has roots going back to the mid 80′s at the very start of the Big Corporate Chain Pharmacy explosion. The independant pharmacists you all revere and hold in such awe are one of the major reasons we are in such a mess today. Yes, JPs generation is to blame. They willingly and happily took the money when the big Corp Chains came a calling. They sold out and now everyone wants to cry about it. How do you think Walgreens and especially CVS got so big? Mainly by buying out independants.

this refers to PBM MAIL order operations that use multiple sites for prescription processing…for example: express Scripts may do data entry in Ft Worth Texas where NO DRUGS ARE DISPENSED, then those Rx’s that are data etered in Ft Worth are actually filled at the ESI facility in Las Vegas (for example). Their is no PBM oversight in the link you provided.

AJ–you’re obviously not an owner. If you can’t comprehend the overreaching power and effects that PBM’s have on our industry by limiting access to Pharamcy providers, keeping higher dollar margin yielding specialty prescriptions for themselves and by incentivizing patient’s to utilize one pharmacy over another based on COPAY structure which INDEPENDENT PHARMACIES have ZERO control over then I can’t help you. I can lead a thirsty horse to water but I can’t make you drink….And something you may not know,the PBM’s use repack NDCS on many of their medications that they fill at their own MAIL order operation which yields higher prices to their CLIENTS(the employers) but the patient doesn’t see the difference in their copay. I’m speaking from 2.5 years experience while working for a MAJOR PBM amil order..

Broncofan7 you can’t see the forest for the trees my confused friend. Take solace in the fact you are not alone.
.
Go back and read the TSBP regs on a class G pharmacy. Let me help you out since apparently they don’t teach reading comprehension anymore.
.
.
TITLE 22 EXAMINING BOARDS
PART 15 TEXAS STATE BOARD OF PHARMACY
CHAPTER 291 PHARMACIES
SUBCHAPTER H OTHER CLASSES OF PHARMACY
RULE §291.153 Central Prescription Drug or Medication Order Processing Pharmacy (Class G)
.
.
2) Any facility established for the primary purpose of processing prescription drug or medication drug orders shall be licensed as a Class G pharmacy under the Act. A Class G pharmacy shall not store bulk drugs, or dispense a prescription drug order.
.
(b) Definitions. The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise. Any term not defined in this section shall have the definition set out in the Act.
.
(1) Centralized prescription drug or medication order processing–The processing of a prescription drug or medication orders by a Class G pharmacy on behalf of another pharmacy, a health care provider, or a payor. Centralized prescription drug or medication order processing does not include the dispensing of a prescription drug but includes any of the following:
.
(A) receiving, interpreting, or clarifying prescription drug or medication drug orders;
(B) data entering and transferring of prescription drug or medication order information;
(C) performing drug regimen review;
(D) obtaining refill and substitution authorizations;
(E) verifying accurate prescription data entry;
(F) interpreting clinical data for prior authorization for dispensing;
(G) performing therapeutic interventions; and
(H) providing drug information concerning a patient’s prescription.

PBM oversight in Texas still falls under the state’s insurance commissioner. Call Ben santana at the TSBP for clarification of your confusion of what a class G pharmacy is. Take solace in the fact that its a fairly new classification and others may be just as confused. That is why it’s so noteworthy what has taken place in Oregon, AJ…

AJ, I gave you an example of a Class G pharmacy in my 1st post on this subject when I noted mail order operations that have a DATA/ order entry location (often called PV1) which would constitute a class G Pharmacy that is SEPARATE from the actual DISPENSING LOCATION RE: Express Scripts Data entry in Ft Worth while order fulfillment(often called PV2) done say in Las Vegas, NV.

But here’s a RETAIL EXAMPLE that may clear up your confusion:

Say I own multiple stores and some are busier than others and could use more help. In an effort to have my employees work in the most efficient manner possible, I could limit my ON SITE staff to doing both DATA ENTRY and fulfillment for Prescriptions for patients who are WAITING.

For those patients who are NOT WAITING and plan on picking up their medications later, I could create a separate offsite OFFICE WITHOUT MEDICATIONS PRESENT that is connected via a uniform computer system with Queues. That OFF SITE LOCATION would be dedicated exclusively to data entry, adjudication, PA, Doctor calls ETC..once the data entry process is complete then the medication order would go into a fulfillment Queue AT EACH LOCAL STORE where the RX would then be physically filled and ultimately dispensed. THAT IS WHAT A CLASS G Pharmacy is…a centralized ORDER PROCESSING FACILITY that ultimately leads to a medication being dispensed at another physical location.

PBM oversight, that is transparency in pricing, stopping the data mining that takes place every time we fill an RX for a patient with insurance at the local level,allowance of the fulfillment of specialty MEDS LOCALLY and mostly the allowing patients to have access to the PHARMACY PROVIDER OF THEIR CHOICE. Those are just a few of the issues facing our profession today that have been artificially brought to bear on our profession by the PBM’s….AJ you’d better get back to your mail order Queues before your boss sees that you didn’t fill your quota 50 rx’s per hour….

Broncofan7 are you really this dense? I know more about this than you can possible imagine! Let me break it down for you….
.
Look under (1) Centralized prescription drug or medication order processing (F) and tell me what it says. Hmmmm thats a big clue……

Broncofan7 you clearly are not going to get this so let me do the equivalent of pulling out a Big Chief Tablet and crayons and draw you a picture.
.
(1) Centralized prescription drug or medication order processing–The processing of a prescription drug or medication orders by a Class G pharmacy on behalf of another pharmacy, a health care provider, or a payor. Centralized prescription drug or medication order processing does not include the dispensing of a prescription drug but includes any of the following:
.
Can you identify which of the follow things are performed at a facility that processes Prior Authorizations?
.
(A) receiving, interpreting, or clarifying prescription drug or medication drug orders;
-YES
(B) data entering and transferring of prescription drug or medication order information;
- YES
(C) performing drug regimen review;
-YES
(D) obtaining refill and substitution authorizations;
- NOPE not this one
(E) verifying accurate prescription data entry;
-NOPE not this either
(F) interpreting clinical data for prior authorization for dispensing;
- YES BINGO!!!! We have a winner.
(G) performing therapeutic interventions; and
- YES
(H) providing drug information concerning a patient’s prescription.
-YES

All of the above items with a YES under them are performed a thousand times a day in the processing of prior authorizations.

As you can see 6 of the 8 items on the list above are performed at a facility that processes prior authorizations. In the first paragraph it specifies Centralized prescription drug or medication order processing includes any of the following. (F) specifically states interpreting clinical data for prior authorization for dispensing. Is there anywhere else you can think of this occurs other than the prior authorization department in a PBM?

Broncofan7 says “PBM oversight, that is transparency in pricing, stopping the data mining that takes place every time we fill an RX for a patient with insurance at the local level,allowance of the fulfillment of specialty MEDS LOCALLY and mostly the allowing patients to have access to the PHARMACY PROVIDER OF THEIR CHOICE. Those are just a few of the issues facing our profession today.

Broncofan7 what makes you think PBM oversight is going to have any effect on the above issues? Nothing you listed is illegal. Nothing you listed currently falls under the jurisdiction of any regulatory agency in the State of Texas. What you listed are legal business practices you don’t like.

Prior Authorizations are nothing more than artificial PBM created road blocks in the dispensing process that are derived from nothing more than PBM’s colluding with certain manufacturers to keep other manufacturers drugs off of that PBM’s Formulary in an effort to make $$ for the PBM and colluding manufacturer. Simple oversight of a PA process is HARDLY “OVERSIGHT OF PBM operations” by the TSBP. PA’s have little to no effect on my ability to provide Pharmacy services to my patients.

When community Pharmacy speaks of OVERSIGHT of PBM’s we are speaking of the issues that effect patient access to providers such as
1) mandatory mail order
2) incentivizing patients to utilize a particular community Pharmacy (like the preferred MED D plans) or mail order via copayments. In Texas these type of benefit plans continually violate the any willing provider statute.
3) MAC pricing oversight via transparency–in regular English: PBM’s would have to define to each provider how and why they are coming up with the MAC value for Generics.
4) Standardization and oversight of the fraudulent charge backs that occur by PBM’s for things as trivial as a Doctor’s address being incorrect in the computer system.

5)Stop the data mining by PBM’s. Everytime I fill an RX for certain large PBM’s they mail my patient’s a letter stating that they could SAVE MONEY on their copays by getting 90 day supplies from the PBM owned mail order operation. So here we have the PBM setting the patient copays and then offering a discounted co-pay to those patients to utilize the Pharmacy that THEY OWN. It doesn’t get much more anti-competitive than that (other than Mandatory mail order).

Now THAT is PBM oversight! ……not your narrow tunnel vision of simply the Prior Authorization process.
Again, besides having to tell the patient that their insurance is AWFUL and contacting the physician, that is not a true barrier to providing service to a willing patient for Community Pharmacy.

Further, why do you suppose that these business practices are currently LEGAL??

Answer: Because it’s a gray area that PBM’s have exploited to their own financial benefit and it is not regulated nearly enough! Hence the NCPA is wanting REFORM via state board oversight.

That’s great broncofan7…what does it have to do with anything? I have already pointed out that the The State Board in Texas licenses pharmacies to include PBM’s via mail order and prior authorization functions. THAT’S ALL THE STATE BOARD CAN DO!!! There function is to protect the public. The give a rats ass about AMP, MAC, rebates, mandatory mail and what ever else you are crying about. These things don’t harm the public. They harm your ability to make a 30% profit margin and the State Board could care less!
.
.
In Texas PBM’s are regulated by The Department of Insurance. They have to register as an administrator. They don’t give a crap about your ability to make a 30% profit like you did 30 years ago.

I quote:
“Department of Insurance (TDI) is authorized under Chapter 4151, Texas Insurance Code, to license and regulate PBMs as administrators. These provisions are geared more toward basic financial practices and business controls as opposed to how PBMs conduct themselves in the marketplace”

You been hiding under a rock broncofan? Your a little late to the party…

http://www.akingump.com/en/news-publications/ftc-closes-antitrust-and-unfair-competition-investigation-of-cvs-caremark-post-merger.html
.
The 2007 merger of CVS and Caremark passed muster without a substantial antitrust investigation. Several years later, advocacy groups were calling for the combination to be broken up in the midst of an ongoing Federal Trade Commission (FTC) investigation.1 For the last two years, the FTC has undertaken essentially a retrospective look at the merger and at complaints that it has harmed consumers, focusing on a litany of allegedly anticompetitive and unfair business practices…
.
…In a press release regarding the FTC settlement, CVS Caremark announced “[t]here were no allegations of antitrust law violations or anti-competitive behavior related to CVS Caremark’s business practices or its products or service offerings. In addition, the Company has received a formal letter from the FTC closing all other aspects of the investigation.”4 In other words, after investigating CVS Caremark for over two years, the FTC’s sole charge relates to practices of a subsidiary that occurred prior to CVS Caremark’s acquisition of the subsidiary, and the agency did not take enforcement action with respect to any of a number of antitrust allegations that were made against the company.

I already stated that PBMS in Texas are regulated by the state insurance commission and NOT the TSBP. The issues that community Pharmacy raise Are directly related to public safety because these immoral business practices by the PBMs are beginning to and have the potential to limit access of the public to the pharmacy provider of THEIR PERSONAL CHOICE. By creating uneven playing fields and artificially manipulating the market by pooling resources these PBMs are providing barriers to patients receiving the medicine from the providers that they trust. The insurance code that you quoted above is all the more reason why the TSBP should work to ensure patient access to the pharmacy provider of their choice by reigning in these unfettered business practices of the renegade PBMs in the interest of protecting the public from consolidation and therefore longer wait times to get their needed drug therapy.

A RICO trial for the PBMs is quite fitting because they are the modern day version of organized crime. I’ve got a nice Sopranos character reference that’ll fit you perfectly but I don’t want to offend the female posters on this blog…

AJ has the audacity to bad mouth the last bastion of pure Pharmacy practice, those Independent Pharmacy owners, while at the same time earning his personal paycheck from the entities which were originally intended as a cost savings mechanism but which have exploded into under regulated profit making middlemen to the tune of millions of dollars while these middlemen continue to squeeze the very providers in the profession that AJs degree makes him a part of by continuing to tilt the playing field in the PBMs favor. He is personally profiteering while taking an active role in the systematic destruction of our profession.

“My interests in this legislation come from listening to my constituents,” Bailey stated. “Patients tell me about their maddening experiences navigating the PBM bureaucracy to get vital prescription drugs at a reasonable price and in a timely fashion. Pharmacists tell me about how PBMs squeeze them to the breaking point as a result of the onerous, take-it-or-leave-it contracts they must sign to have access to patients and about abusive PBM audit practices. The universal complaint is that the current system is broken,” he said. “When people learn about all the questionable business tactics PBMs are allowed to employ on a daily basis without any accountability they are amazed. … While regulation for regulation’s sake is not a panacea, the utter lack of regulation when it comes to the PBM industry must end. I hope my fellow legislators, the governor and people of Oregon will join us in demanding reform. Without these proactive steps patients, health plan sponsors and pharmacies will continue to get the short end of the stick.”

Broncofan7 you don’t have a clue how things work or what the real issues are. Ignorance and misunderstanding drip from every word you type. Don’t fret because 99% of all pharmacists are just like you. Ranting and raving, repeating the same tired aurguments hyperbole. Saying it over and over makes you a fool.

.

I challenge you and anyone else who reads this to take off your blinders, ignore your biases and preconceived notions and take a fresh look at what is going on. Open your mind and really think about it.

.

I will give you a little clue A hundred years ago in every American city you could count on seeing three things every couple of blocks. A Butcher shop, a Bakery and a Pharmacy. If we as a profession don’t change and adapt we are destined to take our place in history next to the independent Butcher and Baker. Think about it….

I have a VERY good idea about “how things work”…for one, I WAS YOU 9 years ago working as a lead in a large mail order operation and later, as head of a PA department including being the URAC compliance officer for our PA department in TEXAS. But then I saw the light…you’re simply lost or don’t care to.

@bronchofan7.. what you seem to ignore.. the insurance industry is exempt from Sherman Anti-trust by the Mc Carran Ferguson Act (1945) http://en.wikipedia.org/wiki/McCarran-Ferguson_Act..
–
So the insurance industry can do things that are illegal for the rest of the business world.
–
The insurance/PBM industry has very deep pockets and are well connected with Congress. IMO.. the FCC has embraced and condoned nearly every action of that industry over the past four + decades.
–
IMO.. our society is headed for some sort of single payor insurance system and to date. the insurance system.. at least initially .. be a vital part of the expansion of that… that will result in a few major players that have a oligopoly..
–
To anyone that is paying attention we are seeing the same process with Part D.. which started in 2006… every year there are fewer player on the field.
–
IMO.. at some point in time.. the players will become so few.. that there will be no need for bidding.. Congress will start fixing prices either per ICD9/ICD10 or capitation..
–
So the next battle will be among the remaining players.. how can they make a profit with what Congress doles out… and we all know who is going to get the short end of that stick.. the pts… and we employees…
–
we – especially in healthcare – are still working under the premise “too big to fail and too small to matter”

Following in the tradition of Medco CEO David Snow, who disregarded neighborhood pharmacists in remarks at a Cleveland Clinic conference last October, Express Scripts CEO George Paz today revealed his apparent less-than-high-esteem for the otherwise highly popular profession.

Associated Press business writer Tom Murphy quoted Paz as saying the following during a conference call with analysts: “At the end of the day … Nexium is Nexium, Lipitor is Lipitor, drugs are drugs, and it shouldn’t matter that much who’s counting to 30.”

“These CEOs told Congress in two recent hearings that they like pharmacists. Their comments about pharmacists in other settings may not rise to contempt of Congress, but they certainly meet the standard for contempt of patient care,” said National Association of Chain Drug Stores (NACDS) President and CEO Steven C. Anderson, IOM, CAE.

“This comment by Express Scripts CEO George Paz rivals the insensitivity toward patients and pharmacists demonstrated by Medco CEO David Snow in his now infamous ‘robots vs. pharmacists’ comment.”

Paz’ latest remark likely will be radioactive among pharmacists, who rightfully bristle at any incorrect and derogatory suggestion that they merely count pills. In fact, NACDS emphasizes pharmacy’s role as the “face of neighborhood healthcare,” emphasizing the “unparalleled value” of pharmacists as demonstrated through services including medication counseling, vaccinations, health screenings and education, and disease-state management.”

@ Pharmaciststeve yet STATES can still impose obligations on the BPMS despite the FEDERAL ANTI TRUST EXEMPTION. That is precisely what Oregon decided to do and why the PCMA fought so hard against the board of Pharmacy regulating it in MS…..

“The Act also provides that federal antitrust laws will not apply to the “business of insurance” as long as the state regulates in that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation. By contrast, most other federal laws will not apply to insurance whether the states regulate in that area or not.[2]“

@Broncofan7… this is probably before your time.. but.. there was a PBM up in the New England area that came out with -at the time – a very low ball fee.. Multiple pharmacies – including chains – declined to sign the new contract..
–
As I remember.. DOJ got involved and threatened all those that declined to sign the contract that they were going to be charged with collusion unless the majority signed this contract.
–
This is a similar situation where we have states making MJ use legal while the FEDS still consider it ILLEGAL product..
–
Our system was suppose to be “states rights”.. but.. that is not is how it has evolved..
–
My concern is FCC & DOJ’s support and endorsement of PBM/Insurance industry and mail order pharmacies over the years… they may not sit idly by…
–
There is a number of areas where some states have started pushing back against the FEDS and their rules/regulations that they believe interfere with “states rights”..
–
The problem is – as I see it – the states only have the ability to tax to fund their activity and the FEDS have the ability to Tax and print money to fund their activities. Yet another unlevel playing field.. and we taxpayers gets to pay when two Goliaths go at it..

Broncofan you say you are from Texas. You should be familar with the politics in this State. You should also be familar with how the TSBP operates.
.
The Texas Board of Pharmacy licenses certain business units with PBMs. What the hell are they supposed to do if tomorrow they are given regulatory authority over the entire PBM operation? The Board inspectors are all pharmacy technicians. What exactly are they going to do?

@AJ.. I have been around the block a few times.. It was my last year in school 69-70 when the “drug cards” came on to the scene.. I had my own store for 20 yrs.. I try to look beyond what is “in our face today” and IMO.. bureaucrats are very predictable.. if you look what they have done in the past. Where do you think that phrase “history tends to repeat itself” probably came from..? Typically they keep reinventing the same concept.. just look at Medicare HMO, Medicare C & Medicare Advantage.. and now they are re-inventing it again on a much larger scale called ACA (Obamacare) and we are going to re-visit capitation for the third or fourth time..
–
Except this time – IMO – they are going to do whatever necessary to cut expenditures.. no matter how many pts are harmed from the “cutting of corners”… thus the concept of “death panels” will be implemented in some sort of manner…. although referred by some other acceptable benign label/term… while the BIG PLAYERS will be trying to figure out how to make the pts believe that they are receiving the best care available.. as opposed to the best care available for the least cost… while the BIG PLAYERS make as much profit as possible… and after a few years.. Congress will not increase capitation rates and/or start cutting capitation rates.
–
In my opinion, the only people that will be happy with this new system is those that don’t have to use it..

Pharmaciststeve it is going to be worse than that. You alluded to it in an earlier post hoe the Medicare DME payments have been reduced to nothing. Here in an excerpt from a Representative Swarkoski’s handbook for her constituents explaining the Affordable Care Act.

.

: The savings achieved by eliminating fraud, waste, abuse and over payments will be the primary funding for The Affordable Care Act.”

.

Obama said this over and over during the run up for the ACA vote. You have you head up your ass if this doesn’t set off about 100 alarm bells. You think Medco and Caremark audits are onerous and unfair. Just wait until a CMS audit contractor comes in and crawls up your ass. You will stop wishing for the days of the independent pharmacy and instead pine away for the days when all you had to worry about was a Medco audit!

.

The only ones who will win are the drug companies and insurance companies. They will make billions while the whole thing turns to shit. You are right about something else Pharmaciststeve, the only ones who will be happy are the ones whondon’t have to use it namly our elected leaders in Washington.

@AJ.. I just had a long time friend have a major stroke and his wife asked me to come in to run his very large HME business – operating in at least 5 states.. This business does a lot of LTC business and the home portion is a relative small portion of the business. In talking to the person that does the billing for that area.. told me the other day that Medicare is 20%-25% of the home billing and that section will take a overall HIT of ~ 10% because of that portion that is Medicare.
–
Over the next few months.. I will be evaluating every section of the business – since I am COO/CFO.. it is within my scope.. and any section that is not providing a net profit directly or indirectly.. will – most likely – be a service that we no longer provide.
–
Providing – or not providing pt care.. will have to be made as a business decision. While I would like to be altruistic in providing care.. but.. this business has some 50 employees and they expect to be paid..

We need more of you to provide that support, we need more of you to be involved in political action, because the issues that we advocate for, and fight for, involve every one of us.

Here are some of the ways that you can serve:
Become politically active. Develop relationships with your elected officials and local candidates for state legislative office.
Become a member of the Political Action Committee Board of Directors. The terms of office are two years and there are a few openings now for directors whose terms expire in August of 2012.
Support the PharmPAC financially. With the support of the pharmacy profession, the PAC had an outstanding financial year in 2012 and is well on its way to do the same in 2013.
Help the PAC in fundraising activities, such as our golf tournament.
Volunteer to participate in in small groups to interview candidates for political office, educating them on pharmacy issues, and helping the PAC in endorsement choices.

“Due to the complexity of specialty drugs, many payers prefer that specialty pharmacies achieve third-party accreditation to confirm their commitment to quality, cost containment and proper utilization. URAC’s Specialty Pharmacy Accreditation is the top choice of payer”

WHITE PAPER= Self Serving, pre-determined hypotheses proven by writing from the Finish line and drawing a straight line backwards to start………

Do you want to know why URAC and these payers are trying to legitimize their collusion under the guise of clinical necessity? I bet you already know the answer—MONEY! today I dispensed 2 boxes of Humira PFS and made $597 gross profit. And that’s at paying my independent Pharmacy AQ cost. These large PBM owned (sometimes) specialty Pharmacies are often times able to bypass the wholesaler altogether to get these specialty meds direct from the manufacturer at a HUGE savings as opposed to the normal channels of distribution. Amerisource-Bergen in Frisco TX is a GREAT EXAMPLE of that. Just another example of collusion and consolidation that needs to be met by the Texas Pharmacy association and American Pharmacies group on the political level…..Even if you’re not an owner, PBM & manufacturer collusion (and now apparently the URAC accrediting body) is going to affect your ability to gain employment as a Pharmacist eventually. Donating a meager $100 a year (2 hours of work for most PRh’s)to the NCPA and your state Pharmacy Associations to go to their legal/political action committees can go a long way in bringing some stability and growth to our profession.

“Due to the complexity of specialty drugs, many payers prefer that specialty pharmacies achieve third-party accreditation to confirm their commitment to quality, cost containment and proper utilization. URAC’s Specialty Pharmacy Accreditation is the top choice of payer”

WHITE PAPER= Self Serving, pre-determined hypotheses proven by writing from the Finish line and drawing a straight line backwards to start………

Do you want to know why URAC and these payers are trying to legitimize their collusion under the guise of clinical necessity? I bet you already know the answer—MONEY! today I dispensed 2 boxes of Humira PFS and made $597 gross profit. And that’s at paying my independent Pharmacy AQ cost. These large PBM owned (sometimes) specialty Pharmacies are often times able to bypass the wholesaler altogether to get these specialty meds direct from the manufacturer at a HUGE savings as opposed to the normal channels of distribution. Amerisource-Bergen in Frisco TX is a GREAT EXAMPLE of that. Just another example of collusion and consolidation that needs to be met by the Texas Pharmacy association and American Pharmacies group on the political level…..Even if you’re not an owner, PBM & manufacturer collusion (and now apparently the URAC accrediting body) is going to affect your ability to gain employment as a Pharmacist eventually. Donating a meager $100 a year (2 hours of work for most RPh’s)to the NCPA and your state Pharmacy Associations to go to their legal/political action committees can go a long way in bringing some stability and growth to our profession.